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Dr. Derek Tracy: Reviewing Bupropion for Depression

Dr. Tracy is a BRC research fellow and the neuromodulation lead at the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London. Dr. Tracy also sits on the Editorial Board of the British Journal of Psychiatry.

Video Library

Antidepressants

Adverse Effects

Suicide Risk and Antidepressants Use

In 1990, case reports described patients who developed intense suicidal ideation during treatment with fluoxetine. In response to this, the manufacturer performed a meta analysis of 17 randomized trials and found no differences in suicidality with placebo.

In 2003 the FDA issued an advisory about suicidality in pediatric patients, this was in response to reports of suicidality in clinical trials. One year later, in 2004, the FDA reexamines the data and issues a warning on increased suicidality in children and adolescents.

In 2005, they studied young adults and decided to issue an advisory on increased suicidality in young adults. Two years later this was included in the current black box warning.

SSRIs

The Mechanism of Action of SSRIs

This presentation is divided in three sections.

The first section is a brief overview of the monoamine theory of depression and its limitations. The second discusses the effects of 5HT1A receptor downregulation on the mechanism of action of SSRIs. The third section presents recent findings on the role of BDNF in depression.

Fluoxetine: The Oldest SSRI

Paroxetine has activating properties that make it a good option for patients with retarded depression or atypical depression. However, we should avoid activation in patients with insomnia and agitation.

There is something that makes fluoxetine unique: its long half-life, we will discuss the advantages and disadvantages of this in clinical practice. This long half-life allowed the development of a weekly capsule. Fluoxetine is a potent inhibitor of the CYP2D6.

Paroxetine: Sexual Dysfunction and Discontinuation Syndrome

Many clinicians see paroxetine as suitable for anxious depression, this is can be considered an interesting clinical tip that might help you choosing an antidepressant. However, this observation hasn’t been specifically addressed in randomized controlled trials.

Regarding its side effects profile, important features include: higher risk for sexual dysfunction, discontinuation syndrome and weight gain.

Citalopram and Escitalopram: Key Similarities and Differences

Citalopram and escitalopram have no significant drug-drug interactions. Citalopram is linked to QT prolongation. This drug was initially approved to be used in a range from 20 to 60 mg/day. In 2011, the FDA recommended against its use in doses higher than 40 mg/day.

SNRIs

Venlafaxine vs Desvenlafaxine: Similar Efficacy

Venlafaxine is a SNRI that is metabolized to O-desmethylvenlafaxine or desvenlafaxine. In 2008 this active metabolite was approved as antidepressant. In this presentation we will see what the two drugs have in common and their differences. They are similar in terms of efficacy, pharmacodynamics and side effects profile.

There are differences in pharmacokinetic aspects and dosing guidelines for these two SNRIs

Antipsychotics

As part of your premium membership you have access to the online course: “Antipsychotics: The Essentials”. The approximate length of this course is 3 hours.

You can download the PPT files and videos for your personal use

Antipsychotics:The Essentials

1- Introduction to Antipsychotic Medications

Antipsychotics History: the discovery of chlorpromazine and clozapine. First Generation Antipsychotics, Second Generation Antipsychotics: terminology and classification. List of Agents. Differences between FGAs and SGAS.

3- Indications for Antipsychotic Agents

Overview of common indications for antipsychotics (including off-label uses).
The effects of antipsychotics on schizophrenia symptoms. Classification of phases in schizophrenia treatment. Basic principles guiding antipsychotic selection.
Comparison of the use of antipsychotics in different phases of bipolar disorder.Use of antipsychotics in depression.

The 5HT1A Receptor in Psychopharmacology

The 5-HT1A receptor is a subtype of serotonin receptor located in presynaptic and postsynaptic regions. Activation of this receptor has been involved in
the mechanism of action of anxiolytic, antidepressant and antipsychotic medications.

This article is an illustrated overview of 5HT1A receptor physiology and its role in psychiatric conditions.